The blog of the Urban Institute
January 18, 2019

Most employers don’t help workers stay employed after illness or injury. Early intervention can help.

January 18, 2019

Two workers get into car accidents and experience similar shoulder injuries. The first worker exhausts his leave benefits and cannot fulfill his usual duties at work. He loses his job and finds that a short-term injury has led to long-term unemployment. The second worker is advised to request a temporary accommodation at work while she recovers from her injury. She fully recovers, and a short-term injury becomes a distant memory.

Every year, millions of workers develop illnesses or suffer injuries that limit their ability to remain on the job. While some—like the second worker—have access to employer-provided early intervention services that help them stay connected to the workforce, many do not.

In our new brief, the third in our disability policy series, we review recent evidence on early intervention services. The evidence suggests that early intervention can improve workers’ employment and health outcomes, increase employee retention, and reduce costs to government programs.

What is early intervention?

Early intervention services support continued employment for workers who develop a new illness or injury or experience a worsening chronic condition that could limit their ability to work or force them to leave the workforce.

The most effective programs intervene soon after a worker acquires a new medical condition and realizes it may prevent work for an extended period. Interventions that occur after a person has been out of the workforce for a substantial period are not “early” and are not as effective (PDF).

Early intervention can take many forms, but effective, evidence-based approaches emphasize strong communication and coordination between the employee, the employer, the health care provider, and the worker’s personal environment. Effective interventions also emphasize work as a positive health outcome and recognize the benefits of continued employment for the worker and employer. These approaches address all areas a worker must navigate while adjusting to life with the new condition, making them more effective than services that address only one area.

Which workers have access to early intervention services?

The US does not require employers to offer early intervention services for newly ill or injured workers. Instead, employer-sponsored programs are voluntary. Early intervention services are most often provided to high-wage, skilled workers employed by large firms, usually as part of a disability management program.

Employers that offer these services typically do so to reduce costs by limiting workers’ compensation claims and days out of work while increasing retention.

But most workers who do not have access to employer-based programs will not be served by government-funded employment support services, such as vocational rehabilitation. Existing programs face limited resources for early intervention, and a large need requires them to prioritize people with the most serious conditions.

Workers who develop a long-term disability and go on to receive Social Security Disability Insurance benefits eventually become eligible for certain return-to-work incentives and programs. These interventions often occur too late to help workers return to work.

What does the evidence on early intervention say?

We looked at evidence from employer-based programs both inside and outside the US, as well as two US-based models of early intervention that are not employer provided but instead leverage a worker’s connection to his or her health care provider. These two models are the Washington State Centers for Occupational Health and Education, which focuses on musculoskeletal workplace injuries, and the Individual Placement and Support model, which supports people with mental illness. Evidence suggests that effective early invention programs do the following:

  1. Improve employment outcomes (e.g., reduced time spent out of the workforce and higher employment rates)
  2. Are effective for many medical impairments, from musculoskeletal conditions like back pain, to common mental health disorders like depression
  3. Address gaps in communication and coordination across all areas of a worker’s life that they must navigate to return to work after a new illness or injury
  4. Can be provided through an employer, health care provider, or government-sponsored intermediary

Options to expand access

In other countries, expanding access to early intervention is largely accomplished through employer mandates. In the US, expanding access is more likely to occur outside of employer-based models through other programs or vehicles, such as workers’ compensation, vocational rehabilitation, paid medical leave, and temporary disability insurance.

Our review of the evidence suggests these approaches could be successful if they include the key elements of effective early intervention models. The US Department of Labor is already taking steps in this direction with the Retaining Employment and Talent after Injury/Illness Network grant program, administered jointly with the Social Security Administration.

Growing interest in establishing a national paid family and medical leave policy presents a promising opportunity for policymakers interested in expanding access to early intervention. A new benefit could be paired with grants to states to test promising models for early intervention that could be expanded over time.

The grants could follow a tiered-evidence approach to fund state experimentation that allows for the development of new models and emphasizes testing and rigorous evaluation to ensure they can be replicated faithfully and expanded.

Today, a few advantaged workers have access to employer-provided early intervention services when they develop a new potentially disabling health condition. All workers deserve the same chance to stay connected to work.

Photo by Alistair Berg via Getty Images.

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